scholarly journals Influence of Oral Anticoagulation and Antiplatelet Drugs on Outcome of Elderly Severely Injured Patients

2021 ◽  
Vol 10 (8) ◽  
pp. 1649
Author(s):  
Maximilian Kerschbaum ◽  
Siegmund Lang ◽  
Leopold Henssler ◽  
Antonio Ernstberger ◽  
Volker Alt ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Elderly Patients ◽  
Oral Anticoagulation ◽  
Head Injuries ◽  
Platelet Aggregation Inhibitors ◽  
Severe Trauma ◽  
Antiplatelet Drugs ◽  
Severely Injured ◽  
Severe Injuries ◽  
Injured Patients

Introduction: Severely injured elderly patients have a poorer prognosis and higher mortality rates after severe trauma compared with younger patients. The aim of this study was to correlate the influence of pre-existing oral anticoagulation (OAC) and antiplatelet drugs (PAI) on the outcome of severely injured elderly patients. Methods: Using a prospective cohort study model over an 11-year period, severely injured elderly patients (≥65 years and ISS ≥ 16) were divided into two groups (no anticoagulation/platelet inhibitors: nAP and OAC/PAI). A comparison of the groups was conducted regarding injury frequency, trauma mechanism, severity of head injuries, and medication-related mortality. Results: In total, 254 out of 301 patients were analyzed (nAP: n = 145; OAC/PAI: n = 109, unknown data: n = 47). The most relevant injury was falling from low heights (<3 m), which led to a significantly higher number of severe injuries in patients with OAC/PAI. Patients with pre-existing OAC/PAI showed a significantly higher overall mortality rate compared to the group without (38.5% vs. 24.8%; p = 0.019). The severity of head injuries in OAC/PAI was also higher on average (AIS 3.7 ± 1.6 vs. 2.8 ± 1.9; p = 0.000). Conclusion: Pre-existing oral anticoagulation and/or platelet aggregation inhibitors are related to a higher mortality rate in elderly polytrauma patients. Low-energy trauma can lead to even more severe head injuries due to pre-existing medication than is already the case in elderly patients without OAC/PAI.

scholarly journals Are There Any Red Flag Injuries in Severely Injured Patients in Older Age?

2021 ◽  
Vol 10 (2) ◽  
pp. 185
Author(s):  
Daniel Popp ◽  
Borys Frankewycz ◽  
Siegmund Lang ◽  
Antonio Ernstberger ◽  
Volker Alt ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Elderly Patients ◽  
Head Injuries ◽  
Older Age ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Younger Patients ◽  
Group 2 ◽  
Injured Patients ◽  
Group 1

Introduction: Severely injured elderly patients pose a significant burden to trauma centers and, compared with younger patients, have worse prognoses and higher mortality rates after major trauma. The objective of this study was to identify the etiological mechanisms that are associated with severe trauma in elderly patients and to detect which injuries correlate with high mortality in elderly patients. Methods: Using a prospect cohort study model over an 11-year period, severely injured patients (ISS ≥ 16) were divided into two age groups (Group 1: 18–64; Group 2: 65–99 years). A comparison of the groups was conducted regarding injury frequency, trauma mechanism, distribution of affected body parts (AIS and ISS regions) and injury related mortality. Results: In total, 1008 patient were included (Group 1: n = 771; Group 2: n = 237). The most relevant injury in elderly patients was falling from low heights (<3 m) in contrast to traffic accident in young patients. Severely injured patients in the older age group showed a significantly higher overall mortality rate compared to the younger group (37.6% vs. 11.7%; p = 0.000). In both groups, the 30-day survival for patients without head injuries was significantly better compared to patients with head injuries (92.7% vs. 85.3%; p = 0.017), especially analyzing elderly patients (86.6% vs. 58.6%; p = 0.003). The relative risk of 30-day mortality in patients who suffered a head injury was also higher in the elderly group (OR: Group 1: 4.905; Group 2: 7.132). Conclusion: In contrast to younger patients, falls from low heights (<3 m) are significant risk factors for severe injuries in the geriatric collective. Additionally, elderly patients with an ISS ≥ 16 had a significantly higher mortality rate compared to severe injured younger patients. Head injuries, even minor head traumata, are associated with a significant increase in mortality. These findings will contribute to the development of more age-related therapy strategies in severely injured patients.

scholarly journals Early Versus Late Spine Surgery in Severely Injured Patients—Which Is the Appropriate Timing for Surgery?

2021 ◽  
pp. 219256822198929
Author(s):  
Arnaldo Sousa ◽  
Cláudia Rodrigues ◽  
Luís Barros ◽  
Pedro Serrano ◽  
Ricardo Rodrigues-Pinto
Keyword(s):  
Mortality Rate ◽  
Spinal Fractures ◽  
Simplified Acute Physiology Score ◽  
Neurological Injury ◽  
Spine Fractures ◽  
Severely Injured ◽  
Intubation Time ◽  
Severely Injured Patients ◽  
Level Of Evidence ◽  
Injured Patients

Study Design: Retrospective cohort study conducted at tertiary spinal trauma referral center. Objective: We aimed to determine if early definitive management of spine fractures in patients admitted to the Intensive Care Unit (ICU) shortens the intubation time and the length of stay (LOS), without increasing mortality. Methods: The medical records of all patients admitted to the ICU and submitted to surgical stabilization of spine fractures were reviewed over a 10-year period. Time to surgery, number of fractured vertebrae, degree of neurological injury, Simplified Acute Physiology Score (SAPS II), ASA score and associated trauma were evaluated. Surgeries performed on the first 72 hours after trauma were defined as “early surgeries.” Intubation time, LOS on ICU, overall LOS and mortality rate were compared between patients operated early and late. Results: Fifty patients were included, 21 with cervical fractures, 23 thoracic and 6 lumbar. Baseline characteristics did not differ between patients in both groups. Patients with early surgical stabilization had significantly shorter intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. After multivariate adjustments overall LOS was significantly shorter in patients operated earlier. Conclusions: Early spinal stabilization (<72 hours) of severely injured patients is beneficial and shortens the intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. Although some patients may require a delay in treatment due to necessary medical stabilization, every reasonable effort should be made to treat patients with unstable spinal fractures as early as possible. Level of Evidence of the Study: Level III.

Vasopressor Use during Emergency Trauma Surgery

2014 ◽  
Vol 80 (5) ◽  
pp. 472-478 ◽  
Author(s):  
Robert M. Van Haren ◽  
Chad M. Thorson ◽  
Evan J. Valle ◽  
Gerardo A. Guarch ◽  
Jassin M. Jouria ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Mortality Rate ◽  
Odds Ratio ◽  
Injury Severity ◽  
Trauma Surgery ◽  
Vital Signs ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Vasopressor Use ◽  
Injured Patients

Most evidence suggests early vasopressor use is associated with death after trauma, but no previous study has focused on patients requiring emergency operative intervention (OR). We test the hypothesis that vasopressors are harmful in this population. Records from 746 patients requiring OR from July 2009 to March 2013 were retrospectively reviewed and stratified based on vasopressor use (epinephrine [EPI], phenylephrine, ephedrine, norepinephrine, dobutamine, vasopressin) or no vasopressor use. Vasopressors were administered to 225 patients (30%) during OR; 59 patients (8%) received multiple vasopressors. Patients who received vasopressors were older, more severely injured, had worse vital signs, and increased mortality rate (all P < 0.001). EPI was independently associated with mortality (odds ratio, 6.88; P = 0.001). If patients who received EPI were excluded, there was no difference in mortality between those who received vasopressors alone or in combination and those that did not (5 vs 6%, P = 0.523), although multiple markers of injury severity were worse. We conclude that vasopressor use is relatively common in the most severely injured patients requiring OR and is associated with mortality. EPI is most often used for cardiac arrest, whereas other vasopressors are used for their vasoconstrictive properties. This suggests that, except for EPI, vasopressors during OR are not independently associated with mortality.

scholarly journals Loss of GPVI and GPIbα contributes to trauma-induced platelet dysfunction in severely injured patients

2020 ◽  
Vol 4 (12) ◽  
pp. 2623-2630 ◽  
Author(s):  
Paul Vulliamy ◽  
Samantha J. Montague ◽  
Scarlett Gillespie ◽  
Melissa V. Chan ◽  
Lucy A. Coupland ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Surface Expression ◽  
Trauma Patients ◽  
Severely Injured ◽  
Platelet Dysfunction ◽  
Severely Injured Patients ◽  
Severe Injuries ◽  
Glycoprotein Vi ◽  
Active Hemorrhage ◽  
Injured Patients

Abstract Trauma-induced coagulopathy (TIC) is a complex, multifactorial failure of hemostasis that occurs in 25% of severely injured patients and results in a fourfold higher mortality. However, the role of platelets in this state remains poorly understood. We set out to identify molecular changes that may underpin platelet dysfunction after major injury and to determine how they relate to coagulopathy and outcome. We performed a range of hemostatic and platelet-specific studies in blood samples obtained from critically injured patients within 2 hours of injury and collected prospective data on patient characteristics and clinical outcomes. We observed that, although platelet counts were preserved above critical levels, circulating platelets sampled from trauma patients exhibited a profoundly reduced response to both collagen and the selective glycoprotein VI (GPVI) agonist collagen-related peptide, compared with those from healthy volunteers. These responses correlated closely with overall clot strength and mortality. Surface expression of the collagen receptors GPIbα and GPVI was reduced on circulating platelets in trauma patients, with increased levels of the shed ectodomain fragment of GPVI detectable in plasma. Levels of shed GPVI were highest in patients with more severe injuries and TIC. Collectively, these observations demonstrate that platelets experience a loss of GPVI and GPIbα after severe injury and translate into a reduction in the responsiveness of platelets during active hemorrhage. In turn, they are associated with reduced hemostatic competence and increased mortality. Targeting proteolytic shedding of platelet receptors is a potential therapeutic strategy for maintaining hemostatic competence in bleeding and improving the efficacy of platelet transfusions.

Influence of late fluid management on the outcomes of severe trauma patients: A retrospective analysis of 294 severely-injured patients

Injury ◽  
2017 ◽  
Vol 48 (9) ◽  
pp. 1964-1971 ◽  
Author(s):  
Mehdi Mezidi ◽  
Mehdi Ould-Chikh ◽  
Pauline Deras ◽  
Camille Maury ◽  
Orianne Martinez ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Fluid Management ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Injured Patients

Prophylactic Inferior Vena Cava Filters

2020 ◽  
pp. 000313482095029
Author(s):  
Adel Elkbuli ◽  
John D. Ehrhardt ◽  
Kyle Kinslow ◽  
Mark McKenney
Keyword(s):  
Inferior Vena Cava ◽  
Hospital Mortality ◽  
Inferior Vena ◽  
Head Injuries ◽  
Vena Cava ◽  
Trauma Patients ◽  
Severely Injured ◽  
Icu Length Of Stay ◽  
Vena Cava Filters ◽  
Injured Patients

Background Patients with major trauma and contraindications to anticoagulation are often considered candidates for a prophylactic inferior vena cava filter (IVCF). Prophylactic IVCFs are controversial in trauma and backed by varying levels of evidence. This study aims to analyze outcomes in severely injured patients who receive IVCFs. Methods A retrospective review of trauma patients aged ≥ 16 years with ISS ≥ 15 admitted to our level 1 trauma center from years 2013 through 2018. Patients were divided into 2 groups: prophylactic IVCF versus VTE chemoprophylaxis. The analysis evaluated demographics, stratified by ISS (15-24, 25-34, ≥35), and subgrouped those with AIS-Head ≥3. Adjusted outcome measures included DVT, PE, mortality, and ICU length-of-stay (ICU-LOS). Results The study sample included 413 patients with prophylactic IVCFs and 2487 on VTE chemoprophylaxis. IVCF placement was associated with higher severity injuries: ISS 28 versus 25 and lower GCS 10.0 versus 11.8, TBI prevalence 83% versus 68% ( P < .001). Patients with IVCFs had increased ICU-LOS (23.2 days vs 12.2 days), DVT (14.8% vs 4.3%), and PE (5.8% vs 1.6%) for patients with ISS <35 ( P < .001). ISS ≥35 was not associated with intergroup DVT or PE rate differences ( P = .81 and .43). No intergroup mortality differences were observed, including after ISS stratification. Among patients with AIS-Head ≥3, prophylactic IVCF was associated with lower in-hospital mortality (8.4% vs 15.7%, P = .001). Conclusions Prophylactic IVCF placement was associated with higher rates of DVT and nonfatal PE, and prolonged ICU-LOS. Prophylactic IVCF placement was not associated with increased in-hospital mortality for severely injured trauma patients. Among patients with concomitant critical head injuries (AIS-Head ≥3), prophylactic IVCF placement was associated with lower in-hospital mortality than VTE chemoprophylaxis.

Use of Alternate Healthcare Facilities as Alternate Transport Destinations during a Mass-Casualty Incident

2010 ◽  
Vol 25 (2) ◽  
pp. 178-182 ◽  
Author(s):  
Erik S. Glassman ◽  
Steven J. Parrillo
Keyword(s):  
Emergency Department ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Urgent Care ◽  
Definitive Treatment ◽  
Severely Injured ◽  
Severe Injuries ◽  
Healthcare Facilities ◽  
Ambulatory Surgery Centers ◽  
Injured Patients

AbstractThe purpose of this discussion is to review the use of destinations other than the hospital emergency department, to transport patients injured as a result of a mass-casualty incident (MCI). A MCI has the ability to overwhelm traditional hospital resources normally thought of as appropriate destinations for the transport of injured patients. As a result, those with less severe injuries often are required to wait before they can receive definitive treatment. This waiting period, either at the scene of the incident or in the emergency department, can increase morbidity and drain resources that can be better directed toward the transport and care of those more severely injured. Potential alternate transport destinations include physician office buildings, ambulatory care centers, ambulatory surgery centers, and urgent care centers. By allowing for transport to alternate locations, these less severely injured patients can be removed rapidly from the scene, treated, and potentially released. This effort can decrease the strain on traditional resources within the system, better allowing these resources to treat more seriously injured patients.

Surgery in the Air — Evacuating Finnish Tsunami Victims from Thailand

2005 ◽  
Vol 94 (1) ◽  
pp. 5-8 ◽  
Author(s):  
A. Leppäniemi ◽  
J. Vuola ◽  
M. Vornanen
Keyword(s):  
Surgical Procedures ◽  
Soft Tissues ◽  
Head Injuries ◽  
Medical Team ◽  
Severely Injured ◽  
Tsunami Disaster ◽  
Lower Extremity Fracture ◽  
Life Saving ◽  
Additional Equipment ◽  
Injured Patients

In connection with the Asian tsunami disaster on December 26, 2004, a specially equipped Finnair B-757 airplane capable of evacuating badly injured patients was remodeled into an ambulance airplane. The vehicle could take up to 22 severely injured or ill patients and intensive care and limited surgical procedures could be provided to the patients. The plane was manned with a civilian medical team of 37 physicians and nurses. The plane left for Thailand to evacuate the most severely injured Finnish citizens within 10 hours of the evacuation decision. A total of 14 patients including 4 critically ill (two on ventilator) were transferred to Helsinki within 32 hours of takeoff. The medical team included a general, an orthopedic and a plastic surgeon. Soft tissue wounds, some of them severely infected, were the most common injuries, followed by extremity fractures and head injuries. The surgical procedures that were performed midair included wound surgery, to remove necrotic tissue, and external fixation and fasciotomy for a lower extremity fracture. The facilities under these circumstances would allow performing life-saving procedures to maintain airway and breathing, and surgical procedures of the soft tissues, extremity and pelvic fractures. Cavitary surgery would require additional equipment and resources.

Magnetic Resonance Imaging after Closed Head Injury in Children

Neurosurgery ◽  
1989 ◽  
Vol 24 (2) ◽  
pp. 223-227 ◽  
Author(s):  
Harvey S. Levin ◽  
Eugenio G. Amparo ◽  
Howard M. Eisenberg ◽  
Michael E. Miner ◽  
Walter M. High ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Head Injuries ◽  
Diffuse Axonal Injury ◽  
Closed Head Injury ◽  
Severely Injured ◽  
Resonance Imaging ◽  
Severely Injured Patients ◽  
Closed Head ◽  
Injured Patients

Abstract Magnetic resonance imaging (MRI) was performed in a series of 21 children and adolescents who had been hospitalized after sustaining closed head injuries of varying severity at least 6 months previously. Areas of high intensity in the parenchyma were present in 8 of the 11 severely injured patients, whereas MRI findings were normal in all 10 patients with mild-to-moderate head injuries. Lesions involving the subcortical white matter were confined to severely injured patients whose clinical features were compatible with diffuse axonal injury. Neuropsychological assessment disclosed deficits primarily in the severely injured patients; these deficits were significantly associated with persistent lesions visualized by MRI. Serial MRI and neurobehavioral assessment following early injury may be useful in documenting cognitive impairment in relation to structural alterations of the young brain.

scholarly journals Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
M. Sinan Bakir ◽  
Rolf Lefering ◽  
Lyubomir Haralambiev ◽  
Simon Kim ◽  
Axel Ekkernkamp ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Injury Severity ◽  
Severe Trauma ◽  
Severely Injured ◽  
Body Parts ◽  
Concomitant Injuries ◽  
Joint Dislocations ◽  
Standardized Treatment ◽  
Extremity Injuries ◽  
Injured Patients

AbstractPreliminary studies show that clavicle fractures (CF) are known as an indicator in the severely injured for overall injury severity that are associated with relevant concomitant injuries in the thorax and upper extremity. In this regard, little data is available for the rarer injuries of the sternoclavicular and acromioclavicular joints (SCJ and ACJ, respectively). Our study will answer whether clavicular joint injuries (CJI), by analogy, have a similar relevance for the severely injured. We performed an analysis from the TraumaRegister DGU (TR-DGU). The inclusion criterion was an Injury Severity Score (ISS) of at least 16. In the TR-DGU, the CJI were registered as one entity. The CJI group was compared with the CF and control groups (those without any clavicular injuries). Concomitant injuries were distinguished using the Abbreviated Injury Scale according to their severity. The inclusion criteria were met by n = 114,595 patients. In the case of CJI, n = 1228 patients (1.1%) were found to be less severely injured than the controls in terms of overall injury severity. Compared to the CF group (n = 12,030; 10.5%) with higher ISS than the controls, CJI cannot be assumed as an indicator for a more severe trauma; however, CF can. Concomitant injuries were more common for severe thoracic and moderate upper extremity injuries than other body parts for CJI. This finding confirms our hypothesis that CJI could be an indicator of further specific severe concomitant injuries. Despite the rather lower relevance of the CJI in the cohort of severely injured with regard to the overall injury severity, these injuries have their importance in relation to the indicator effect for thoracic concomitant injuries and concomitant injuries of the upper extremity. A limitation is the collective registration of SCJ and ACJ injuries as one entity in the TR-DGU. A distorted picture of the CJI in favor of ACJ injuries could arise from the significantly higher incidence of the ACJ dislocation compared to the SCJ. Therefore, these two injury entities should be recorded separately in the future, and prospective studies should be carried out in order to derive a standardized treatment strategy for the care of severely injured with the respective CJI.

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